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BACKGROUND: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING: Bill & Melinda Gates Foundation.

Aim: Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education. Purpose: To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides. Conclusion: Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.

Diagnosis is a prerequisite for successful professional problem-solving: A physician identifies an appropriate treatment based on a diagnosis of the patient’s disease, and a teacher selects an appropriate learning task based on an assessment of the student’s prior knowledge. Education in academic professions such as medicine or teaching is often focuses on the acquisition of conceptual knowledge from lectures and books; opportunities for students to engage in practical diagnostic situations are typically rare. However, applying such conceptual knowledge in diagnostic activities is regarded as necessary for developing diagnostic competences. In this article, we focus on simulations in which students can actively engage in practicing diagnostic activities concerning cases from professional practice. We review and link research perspectives on diagnostic competences, their components and their development. This is partly done by exploring the commonalities and differences in research on diagnostic competences in medicine and teaching. Then, we present approaches to simulation, followed by different types of instructional support in such simulations. In particular, we focus on different forms of scaffolding during problem-solving, and on the possibly complementary roles of expository forms of instruction in these kinds of environments. Building on the perspectives reviewed, we propose a framework for fostering diagnostic competences in simulations in higher education and outline an interdisciplinary research approach concerning the instructional design of such simulations.

PURPOSE: Consensus group methods, such as the Delphi method and nominal group technique (NGT), are used to synthesize expert opinions when evidence is lacking. Despite their extensive use, these methods are inconsistently applied. Their use in medical education research has not been well studied. The authors set out to describe the use of consensus methods in medical education research and to assess the reporting quality of these methods and results. METHOD: Using scoping review methods, the authors searched the Medline, Embase, PsycInfo, PubMed, Scopus, and ERIC databases for 2009-2016. Full-text articles that focused on medical education and the keywords Delphi, RAND, NGT, or other consensus group methods were included. A standardized extraction form was used to collect article demographic data and features reflecting methodological rigor. RESULTS: Of the articles reviewed, 257 met the inclusion criteria. The Modified Delphi (105/257; 40.8%), Delphi (91/257; 35.4%), and NGT (23/257; 8.9%) methods were most often used. The most common study purpose was curriculum development or reform (68/257; 26.5%), assessment tool development (55/257; 21.4%), and defining competencies (43/257; 16.7%). The reporting quality varied, with 70.0% (180/257) of articles reporting a literature review, 27.2% (70/257) reporting what background information was provided to participants, 66.1% (170/257) describing the number of participants, 40.1% (103/257) reporting if private decisions were collected, 37.7% (97/257) reporting if formal feedback of group ratings was shared, and 43.2% (111/257) defining consensus a priori. CONCLUSIONS: Consensus methods are poorly standardized and inconsistently used in medical education research. Improved criteria for reporting are needed.

Abstract Study success includes the successful completion of a first degree in higher education to the largest extent, and the successful completion of individual learning tasks to the smallest extent. Factors affecting study success range from individual dispositions (e.g., motivation, prior academic performance) to characteristics of the educational environment (e.g., attendance, active learning, social embeddedness). Recent developments in learning analytics, which are a socio-technical data mining and analytic practice in educational contexts, show promise in enhancing study success in higher education, through the collection and analysis of data from learners, learning processes, and learning environments in order to provide meaningful feedback and scaffolds when needed. This research reports a systematic review focusing on empirical evidence, demonstrating how learning analytics have been successful in facilitating study success in continuation and completion of students’ university courses. Using standardised steps of conducting a systematic review, an initial set of 6220 articles was identified. The final sample includes 46 key publications. The findings obtained in this systematic review suggest that there are a considerable number of learning analytics approaches which utilise effective techniques in supporting study success and students at risk of dropping out. However, rigorous, large-scale evidence of the effectiveness of learning analytics in supporting study success is still lacking. The tested variables, algorithms, and methods collected in this systematic review can be used as a guide in helping researchers and educators to further improve the design and implementation of learning analytics systems.

Many have argued that the development of artificial intelligence has more potential to change higher education than any other technological advance.For instance, Klutka et al. ( 2018) has listed the following goals for AI in higher education:However, these are aspirational goals.What is the reality, at least as we enter the 2020s?The purpose of this special edition, as expressed in the journal's call for papers, is to examine the potential and actual impact of artificial intelligence (AI) on teaching and learning in higher education.

The two most influential traditions of contemporary theorizing about democracy, social choice theory and deliberative democracy are generally thought to be at loggerheads, in that one demonstrates the impossibility, instability or meaninglessness of the rational collective outcomes sought by the other. We argue that the two traditions can be reconciled. After expounding the central Arrow and Gibbard–Satterthwaite impossibility results, we reassess their implications, identifying the conditions under which meaningful democratic decision making is possible. We argue that deliberation can promote these conditions, and hence that social choice theory suggests not that democratic decision making is impossible, but rather that democracy must have a deliberative aspect.

BACKGROUND: Considering patients' experience is essential for optimal decision-making. However, despite increasing recognition of the impact of costs on oncology care, there is no patient-reported outcome measure (PROM) that specifically describes the financial distress experienced by patients. METHODS: The content for a comprehensive score for financial toxicity (COST) was developed with a stepwise approach: step 1) a literature review and semistructured, qualitative interviews with patients for content generation; step 2) patients' assessment of the items for importance to their quality of life; step 3) pilot testing assessing interitem (IIC) and item-total (ITC) correlations to identify redundancy (Spearman rho, > 0.7) and statistically unrelated content (P > .05); and step 4) exploratory factor analysis. Sociodemographic data were collected. RESULTS: In total, 155 patients with advanced cancer who were receiving treatment (20 patients in step 1, 35 patients in step 2, and 100 patients in steps 3 and 4) participated in the PROM development. In step 1, the literature was reviewed, and 20 patients generated 147 items, which were reduced to 58 items because of redundancy. In step 2, 35 patients rated the 58 items on importance, and 30 items were retained. In step 3, 46 patients assessed the 30 items, 14 items were excluded because of high IIC, and 3 were excluded because of nonsignificant ITC. In step 4, 2 items were discarded because of poor loadings in a factor analysis of 100 patients, resulting in an 11-item PROM. CONCLUSIONS: The content for a financial toxicity PROM was developed in 155 patients. The provisional COST measure demonstrated face and content validity as well as internal consistency and should be validated in larger samples.